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Small bowel MR enterography: problem solving in Crohn's disease.

Griffin N, Grant LA, Anderson S, Irving P, Sanderson J - Insights Imaging (2012)

Bottom Line: Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations.MRE can help address this question.The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK, nyreegriffin100@gmail.com.

ABSTRACT
Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages • MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. • MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. • MRE can help define disease activity, a key question in the management of Crohn's disease. • MRE can help distinguish between inflammatory, stricturing and penetrating disease. • MRE can demonstrate both mural and extramural complications.

No MeSH data available.


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Example of fibrostenotic disease: coronal HASTE image shows a stricture in the neoterminal ileum in a patient with previous ileocolic resection; this is of intermediate to low signal due to little mural oedema (arrows); there is pre-stenotic dilatation
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Fig8: Example of fibrostenotic disease: coronal HASTE image shows a stricture in the neoterminal ileum in a patient with previous ileocolic resection; this is of intermediate to low signal due to little mural oedema (arrows); there is pre-stenotic dilatation

Mentions: The affected bowel wall in active inflammation demonstrates higher signal intensity on T2-weighted images due to the presence of mucosal or submucosal oedema (Figs. 6a, 7a). Good correlation has been shown between mural hyperintensity on T2-weighted images, biological parameters (such as CDAI and CRP) and histopathology [17, 18]. In fibrostenotic disease, the bowel wall appears of lower signal due to the presence of fibrosis (Figs. 8, 9a). Sometimes in chronic disease, submucosal fat deposition occurs, which is also of high signal on T2-weighted images. As mentioned earlier, the use of a fat-suppressed T2-weighted sequence can thus be helpful in distinguishing submucosal fat from oedema.Fig. 6


Small bowel MR enterography: problem solving in Crohn's disease.

Griffin N, Grant LA, Anderson S, Irving P, Sanderson J - Insights Imaging (2012)

Example of fibrostenotic disease: coronal HASTE image shows a stricture in the neoterminal ileum in a patient with previous ileocolic resection; this is of intermediate to low signal due to little mural oedema (arrows); there is pre-stenotic dilatation
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369125&req=5

Fig8: Example of fibrostenotic disease: coronal HASTE image shows a stricture in the neoterminal ileum in a patient with previous ileocolic resection; this is of intermediate to low signal due to little mural oedema (arrows); there is pre-stenotic dilatation
Mentions: The affected bowel wall in active inflammation demonstrates higher signal intensity on T2-weighted images due to the presence of mucosal or submucosal oedema (Figs. 6a, 7a). Good correlation has been shown between mural hyperintensity on T2-weighted images, biological parameters (such as CDAI and CRP) and histopathology [17, 18]. In fibrostenotic disease, the bowel wall appears of lower signal due to the presence of fibrosis (Figs. 8, 9a). Sometimes in chronic disease, submucosal fat deposition occurs, which is also of high signal on T2-weighted images. As mentioned earlier, the use of a fat-suppressed T2-weighted sequence can thus be helpful in distinguishing submucosal fat from oedema.Fig. 6

Bottom Line: Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations.MRE can help address this question.The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK, nyreegriffin100@gmail.com.

ABSTRACT
Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages • MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. • MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. • MRE can help define disease activity, a key question in the management of Crohn's disease. • MRE can help distinguish between inflammatory, stricturing and penetrating disease. • MRE can demonstrate both mural and extramural complications.

No MeSH data available.


Related in: MedlinePlus